Comparison Of Safety Of Different Anesthesia Methods In Minimally Invasive Surgery Of Nanosecond Pulse Non-thermal Ablation For Hepatocellular Carcinoma

Background and PurposeNanosecond pulse electric field(ns PEF)is a new type of non-thermal local interventional tumor ablation method that uses high-voltage ultra-short pulse to release energy to destroy tumors.The clinical operation requirements are similar to radiofrequency ablation(RFA)and microwave ablation(MWA).Under anesthesia,medical imaging methods such as ultrasound or computer tomography(CT)are used for percutaneous puncture,positioning of the ablation range,ablation treatment,postoperative follow-up,etc.Unlike the currently widely used thermal ablation technology,nanosecond pulses are a type of non-thermoelectric ablation.The application of high-power electric fields(above ten thousand volts)and short-time(nanosecond-level)high-energy ultrashort pulses causes irreversible electroporation of cell membranes to ablate tumors.While high-voltage pulses effectively destroy tumors,high-frequency and high-energy electrical stimulation may have the potential to cause arrhythmias and muscle twitches.Therefore,it is necessary to focus on monitoring cardiac safety and reducing muscle twitches during anesthesia.There are no previous clinical basic studies in this field.In this paper,rabbit VX2 orthotopic liver cancer model is used to simulate two commonly used laparotomy and ultrasound guided surgical methods for clinical ablation,and the clinical safety of nanosecond pulse electrical ablation under inhalation and intravenous anesthesia methods is studied.Materials and methodsTwenty-eight VX2 liver cancer-bearing rabbits were randomly divided into an open operation + anesthesia with 10% chloral hydrate,an open operation + anesthesia with Su Mian Xin ? + 10% chloral hydrate + isoflurane,an ultrasound guided puncture + anesthesia with Su Mian Xin ? + 10% chloral hydrate + isoflurane,an ultrasound guided puncture + anesthesia with Su Mian Xin ? + 10% chloral hydrate + isoflurane + aticaine,7 rabbits in each group.Each group was given 500 electric field strengths of 15 k V / cm,20 k V / cm,and 25 k V / cm nanosecond pulses.Heart rate,heart rhythm and respiratory rate were monitored from 15 minutes before surgery to 10 minutes after treatment.Body movements,operation time,resuscitation time,anesthesia-related complications and survival time were recorded during the operation.ResultIn the treatment of laparotomy,Su Mian Xin ? combined with 10% chloral hydrate and isoflurane anesthesia is better than simple 10% chloral hydrate anesthesia.In the treatment of hepatocellular carcinoma with nanosecond pulses under ultrasound guided percutaneous puncture,local anesthesia with aticaine before needle insertion has obvious advantages in controlling respiratory frequency.ConclusionNanosecond pulse ablation for hepatocellular carcinoma has high requirements for anesthesia.It has initially confirmed the safety of intravenous composite inhalation anesthesia in nanosecond pulse treatment of hepatocellular carcinoma and provides a basis for clinical application.